In Syria, Addressing Medical Needs In An Embattled City

Now to the civil war in Syria. Rebels report new rocket strikes by government forces today - attacks, they say, that killed six members of one family. Nearly two years after the government sent army tanks to crush anti-government protests, U.N. Secretary-General Ban Ki-moon said yesterday he does not see much prospect for a negotiated resolution, and he warned that the humanitarian situation in the country is dire.

SECRETARY-GENERAL BAN KI-MOON: Lack of food and denial of access to medical treatment, inadequate shelter and heating during a harsh winter, are taking toll. We continue to see unrelenting violence and human rights violations. The use of heavy weapons in urban centers is causing terrible damage, with whole towns and neighborhoods emptied or destroyed. Sexual violence is widespread.

CONAN: Perhaps no place in Syria is more affected than Aleppo in the northern part of the country. NPR correspondent Deborah Amos has been reporting on the situation there. She'll join us in a moment. But we begin with Shinjiro Murata, the head of mission for Doctors Without Borders in Aleppo. And thanks very much for being with us today.

DR. SHINJIRO MURATA: (Unintelligible)

CONAN: Can you tell us what you've been seeing today - new attacks, new patients?

MURATA: Well, today it was a quiet day, so we didn't receive so many trauma patients related with war wounded. But usually when we have bombing or shelling or surface-to-surface missiles near our location, we receive a number of trauma cases among civilians.

CONAN: Just earlier this month there was an attack like the one you described in a market in the city of Azaz, which is nearby, and your group received many of the wounded and sadly many of those killed as well.

MURATA: Yes. It was a terrible January; an air bombing hit the main market in Azaz town. And soon after that, we received in total 25 patients, including five dead arrivals, and so only 20 patients, but all of them were civilians.

CONAN: And is the secretary-general's description of the medical resources available to the population, is he accurate when he describes it as dire?

MURATA: People - civilians are - they're suffering from the lack of access to the trauma care and actually not only trauma care but also obstetric care and basic primary health care, and they have - people have no access to medicines for chronic diseases. So actually in the Syria conflict, it's not only trauma patients but also many people are suffering from the lack of access to health care.

CONAN: And are most of the patients you see there for treatment of wounds, for trauma?

MURATA: Not - yes, we receive a lot of trauma cases related with war wounded, but also we are receiving a lot of pregnant women for delivery cases. For example, in January until yesterday, 23rd of January, we had, in our health facility, we had 148 delivery cases, 148 delivery cases in 23 days.

CONAN: And what kind of resources are now left for your Syrian colleagues who would ordinarily be treating those cases?

MURATA: Well, first of all, the medical health facilities are tended to be targeted of air bombing or shelling attacks. So many structures had been destroyed. And also the equipments and supplies for anesthesia and surgery are in short supply in numerous hospitals. So hospitals are suffering, also, from the lack of the support of supply.

CONAN: And you work there with Doctors Without Borders with the permission of the Syrian government?

MURATA: No. We have not officially authorized to have our medical activities inside Syria.

CONAN: So are you under pressure? Are you under attack?

MURATA: Well, we have been negotiating with them to gain an official authorization, but so far, it's not succeeded. And we are operating our medical activities in the area which we can have our humanitarian space, which is not the governmental area.

CONAN: And do you, there, treat injured soldiers from the Syrian army? Do you treat injured fighters from the Free Syrian Army, the rebels?

MURATA: Of course, as a medical organization, we keep our impartiality and neutrality for the conflict. So whoever arrives to our facilities are patient. We treat them equally.

CONAN: You worked in other war zones in other parts of the world. How does Syria compare?

MURATA: In this conflict, the remarkable thing is that many, many key civilian infrastructures, such as medical facilities, schools and bakeries, fuel stations - are targeted. So in terms of the normal life of civilians, they are in a worse situation than the other conflict I possibly know, I think.

CONAN: Let me turn - let me turn to my colleague Deborah Amos. She's with us from New York. And, Deb, is - the situation as being described, does it add up to the kind of humanitarian catastrophe that the U.N. secretary general was talking about?

DEBORAH AMOS, BYLINE: Yes, Neal. I've done lots of reporting about doctors inside Syria. I have been following, for quite some time, the Syrian American Medical Society here — has been setting up training programs. I reported on one a while ago. It was a trauma training program. Two doctors came out from the Mayo Clinic, and they were actually teaching people how to set broken legs without anesthetic, because these doctors inside don't have anesthetics. And they said, you know, it sounds horrible, but in fact, people feel better after their legs are set and them you can move them into some side(ph) - kind of clinic.

And when these doctors from the States arrive, they bring needed and necessary supplies in their suitcases. And there was one occasion where a young neurosurgeon, finally, for the first time, got a brain drill, a manual drill, which is necessary to treat people who have gunshot wounds to the head. Up until then, he had to send them off to Turkey to be treated, which means that it risks their lives even further. All time in medicine is crucial. So if you have to make that bumpy ride across the border, you are more likely to die. So he was absolutely delighted that he got this piece of equipment.

But I think we have been hearing, now, specific details, today, of the kind of conditions that are across Syria where there's not enough medicine, and now, there's not enough food.

CONAN: And the description we heard from Shinjiro Murata, of the Doctors Without Borders, that medical facilities have been attacked. Have they been systematically attacked, and is that because they treat the wounded from the Free Syrian Army, the rebels?

AMOS: There have been quite a few reports that human rights organizations have documented a systematic targeting of doctors, of field clinics. Doctors have testified that they have been punished, arrested. Some of them have been shot for treating rebels, for treating civilians who live in rebel-controlled areas. That has been a pattern since sometime last year.

CONAN: Shinjiro Murata, Deborah Amos has been telling us about shortages of food. Are you seeing malnutrition in your patients?

MURATA: Yes. Sometimes we have malnutrition children among under five years old but not - it's not majority yet. But for sure, we are receiving also a lot of report of shortage of food, bread, created by the shortage of fuel.

CONAN: And as you look at the situation, obviously, it's winter in Syria, as it is in the fascinated Northern Hemisphere everywhere. How is the cold affecting things?

MURATA: The cold is affecting especially the life of internally displaced people. Every day in the border point, there are new arrivals, mainly from the fear over the security situation. And these are the ones who are the most vulnerable people who don't have enough warm clothes, blankets, and they are suffering. And we're also distributing blankets and warm clothing at border point.

CONAN: And, Deborah Amos, we keep, of course, reporting on military developments, diplomatic developments, the people suffering is something that cannot be overlooked.

AMOS: It's a catastrophe, and it will continue to be catastrophe. Syria was a country that prided itself on feeding itself. Fifty percent of the country worked in agriculture, so much of the fighting in farm lands. And as the doctor rightly pointed out, there is not enough fuel. And so those farm lands cannot be farmed. This will not only affect the rebel-held areas, it will affect the government-held areas. There is simply not going to be enough food over the next year. Already, in the government-held areas, they can't get extra wheat because of the sanction so they can't get the money out to buy the extra wheat that they are going to need.

This is the next great crisis that is coming, that will add to the suffering of these civilians who are already suffering because of the cold, because of the lack of bread and because of the targeting of breadlines. That is something else that has been happening in the north. Government - the government air force pilots have been targeting these places, Aleppo, in particular. And I'm sure the doctor can talk about the patients that he sees who are being harms(ph) while they stand in line for bread.

CONAN: As you mentioned earlier. Shinjiro Murata, we thank you very much for your time today and we wish you many more quiet days.

MURATA: We hope so too.

CONAN: Shinjiro Murata is the head of mission for Doctors Without Borders in their facility outside of Aleppo, the major city in Syria. You're listening to TALK OF THE NATION from NPR News.

And Deb Amos is still with us from New York. And I wanted to ask you, Deb, getting back to some of the diplomatic developments. We've heard the Russians downplaying reports of their people being transported out of Syria to Beirut so they could be airlifted back to Russia.

AMOS: About 100 left, mostly women and children. But there are reports today that more than 1,000 Russians have been at the mission in Damascus asking to be evacuated. And if you look at some of the quotes of the people who landed in Moscow, they say, we can no longer live in Syria. It is not safe. We have lost everything. There is no work. And I think that, diplomatically, the Russians have been playing down this evacuation. But quietly, they have also been planning for a much large evacuation, perhaps, by ship. They do have a port in Tartus, which is on the Mediterranean. And if the fighting gets more serious, I think the Russians will no choice, no matter what diplomatic message that sends.

CONAN: And Russia also said to be closing its consulate in Aleppo, just another small step.

AMOS: It was surprising to me that it was open, to tell you the truth, when they announced that they has closed it what they suggested for Russians living in Syria is they would have to go to Damascus to be able to deal with any diplomatic issues, which I think is going to be tough for some of them. If you live across the country, it is very difficult to drive into the capital. You have military checkpoints. You have rebel checkpoints. I think that's why 100 women and children took their chance today. What was very interesting, and let's talk about diplomatic messaging, is they didn't leave out of Damascus - out of the Damascus International Airport. They went overland into Beirut.

Now, this has been a contention between the Syrian rebels and the regime. The regime has worked very hard to keep that airport open. The rebels have been pressing around the airport to keep it close because they know it is a symbol. And when the Russians had to evacuate, they didn't us Damascus International Airport. They moved people out of Beirut.

CONAN: After another trip in and around Syria, you had a chance to catch your breath a little bit there in New York. I wonder -as you get some perspective on this situation, what concerns you the most?

AMOS: That it so - it is so - we are so far away from a diplomatic resolution, and you know what that means. It means more death as both sides continue to press their case on the battlefield. Now, today, Turkish officials want the international community to declare bombing civilians a war crime. This now is the biggest danger for civilians, especially in the North. As the rebels take their fight to the regime, the regime takes their fight to the civilians. And there seems to be a tactic to try to separate civilians who support the rebels by punishing them for their support.

And now, the Turks are asking that this becomes a war crime. I'm not sure if they can get that resolution in the United Nations. We know that the U.N. is deadlocked over this issue. But that the fact that they are raising it now does bring some attention, if more attention needs to be paid to this idea that you can be standing in a breadline and you could be bombed by your own air force.

CONAN: NPR's Deborah Amos, who's in New York in part, to receive the Columbia-duPont award for the outstanding work she and NPR's Kelly McEvers have done covering the war in Syria. Deb, congratulations.

AMOS: Thank you. Thank you, Neal.

CONAN: NPR correspondent Deborah Amos with us from our bureau in New York. Tomorrow, as the Senate Foreign Relations Committee prepares to consider John Kerry for secretary of state, we'll talk about what it takes to be a diplomat these days. It's the TALK OF THE NATION from NPR News. I'm Neal Conan in Washington. Transcript provided by NPR, Copyright NPR.